Human cholestatic hepatitis owing to polyoxyethylene nonylphenol ingestion A case report
- Abstract
- Rationale: The purpose of this study was to identify the chemical responsible for cholestatic hepatitis in a 55-year-old woman who ingested 1,10-iminodi (octamethylene) diguanidinium triacetate (iminoctadine triacetate), a fungicide. The fungicide formulation was also composed of polyoxyethylene nonylphenol (NP-40) and methanol. Patient concerns: Severe cholestatic hepatitis developed, which led to the patient's death on day 88 of hospitalization. Postmortem necropsy of the liver showed focal hepatocyte necrosis involving mostly the mid-zone, along with intracytoplasmic and intracanalicular cholestasis. Diagnoses: To identify the chemical responsible for hepatic injury, the cellular toxicity of all chemicals in the fungicide formulation was assessed in HepG2 cells using the 3-(4,5-dimethylthiaxol-2yl)-2, 5-diphenyl tetrazolium bromide test. Outcomes: Viability of cells treated with the surfactant NP-40 was significantly lower (P<.001), but that of cells treated with other components of the fungicide, including the active ingredient, iminoctadine triacetate, was unaffected. Fluorescence-activated cell sorting analysis confirmed that necrosis was induced in HepG2 cells treated with 25-80 mu M of NP-40, while significant numbers of apoptotic cells were not detected. Lessons: NP-40 appears to be the chemical responsible for the patient's irreversible hepatic injury, accompanied by intracytoplasmic and intracanalicular cholestasis.
- All Author(s)
- J. Min
; J. Han
; K. Kim
; S. Park
; S. Lee
; J. Hong
; H. Gil
; H. Song
; S. Hong
- Issued Date
- 2017
- Type
- Article
- Keyword
- cholestatic hepatitis; iminoctadine triacetate; pesticide poisoning; polyoxyethylene nonylphenol; surfactants
- Publisher
- Lippincott Williams & Wilkins
- ISSN
- 0025-7974
; 1536-5964
- Citation Title
- Medicine
- Citation Volume
- 96
- Citation Number
- 32
- Citation Start Page
- e7737
- Citation End Page
- e7737
- Language(ISO)
- eng
- DOI
- 10.1097/md.0000000000007737
- URI
- http://schca-ir.schmc.ac.kr/handle/2022.oak/2404
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